A model of pulsations in communicating hydrocephalus
A model of pulsations in communicating hydrocephalus
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DOI：
10.1159/000063533
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发表时间：
2002-06-01
影响因子：
0.7
通讯作者：
Davis, R
中科院分区：
文献类型：
--
作者：
Egnor, M;Zheng, LL;Davis, R
传统的交通性脑积水理论暗示了脑脊液运动的大流量成分；也就是说，脑积水通常被理解为脑脊液形成和吸收之间的不平衡。交通性脑积水的原因是蛛网膜绒毛对脑脊液吸收不良的理论没有得到实验证据或物理推理的证实。血流敏感MRI显示，几乎所有脑脊液运动都是搏动的，有大量证据表明，高动力脉络膜丛搏动对于交通性脑积水患者的心室扩张是必要和充分的。我们根据电路中电子的脉动运动与颅骨中血液和脑脊液的脉动运动之间的类比，建立了颅内脉动模型。蛛网膜下腔对脑脊液脉动流动的阻抗增加，重新分配了进入脑脊液和毛细血管和静脉循环的脉动流。交通性脑积水的显著特征，如脑室扩张、颅内压波、脑脊液-静脉压梯度变窄、脑血流量减少、阻力指数升高、脑脊液吸收不良等，从模型中自然显现出来。我们认为通讯性脑积水是脑脊液脉冲在头盖骨内重新分布的结果。版权所有(C) 2002 S. Karger AG，巴塞尔。
The traditional theory of communicating hydrocephalus has implicated the bulk flow component of CSF motion; that is, hydrocephalus is generally understood as an imbalance between CSF formation and absorption. The theory that the cause of communicating hydrocephalus is malabsorption of CSF at the arachnoid villi is not substantiated by experimental evidence or by physical reasoning. Flow-sensitive MRI has shown that nearly all CSF motion is pulsatile, and there is substantial evidence that hyperdynamic choroid plexus pulsations are necessary and sufficient for ventricular dilation in communicating hydrocephalus. We have developed a model of intracranial pulsations based on the analogy between the pulsatile motion of electrons in an electrical circuit and the pulsatile motion of blood and CSF in the cranium. Increased impedance to the flow of CSF pulsations in the subarachnoid space redistributes the flow of pulsations into the ventricular CSF and into the capillary and venous circulation. The salient features of communicating hydrocephalus, such as ventricular dilation, intracranial pressure waves, narrowing of the CSF-venous pressure gradient, diminished cerebral blood flow, elevated resistive index and malabsorption of CSF, emerge naturally from the model. We propose that communicating hydrocephalus is the result of a redistribution of CSF pulsations in the cranium. Copyright (C) 2002 S. Karger AG, Basel.